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Home My WebLink AboutBLDP-21-004360 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 2/2/21 PERMIT# BLDP-21-004360 JOBSITE ADDRESS 12 JONQUIL RD OWNERS NAME Denis Nagle P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURES-I FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM _ DEDICATED GRAY WATER SYSTEM _ DEDICATED WATER RECYCLE SYSTE _ DISHWASHER _ DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ BOND❑ OWNERS INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that at plumbing work and installations performed under the permit issued for this application will be in compliance with at Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Denis Nagle LICENSE'1O951 SIGNATURE MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑# J LLC ❑# COMPANY NAME Denis M Nagle ADDRESS 41 1/2 SPEEN ST CITY NATICK STATE MA ZIP 017604114 TEL L FAX CELL EMAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK —'111W ° CITY �1/rl CO` MA DATE —JS :)j1/ PERMIT#1WI.7—Z' • —� JOBS! ADDRESS /c ,1 :a %/'::s' OWNER'S NAME S f 1 OWNER ADDRESS 1/ t'(''1 Sl /;-Ay TE 7 �'� -7 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL, PRINT CLEARLY NEW: RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES Z FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _ , DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY . r ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET / r URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER • INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will berfila Hance with II Pe ' ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _ PLUMBER'S NAME LICENSE#/0 1.5/ IGNATURE MP Yi JP❑ CORPORATION❑# PARTNERSHIP 0# LLC❑# // COMPANY NAME_ /L- (L Q ei-47261/ ADDRESS /// V720) 3-r CITY / 'i ,/-(� X STATE MIL ZIP 0/ 7(,C7 TEL FAX CELL.5t) St J 4;06 q EMAIL ��_C n ►1'1 ��/�/.a ` /I') 0, ,4•YaM e TOWN OF YAROUTH d BUILDING DEPARTMENT 1146 Route 28,South Yarmouth,MA 02664 508-398-2231 ext.1261 HOMEOWNER LICENSE;,L EXEMPTION PLEASE P DATE: / OZ/ aCC) \. JOB LO ATION: Nide.,' � U0 -tit/_l. ) ril/f i)0(71-fL1 I N STREET • �I RESS ECTI F TOWN - "HOMEOWNER" _yen/ s l ia31(.. Sib_ (01 - (o c L{ NAME , HOME PHONE WORK PHONE PRESENT MAILING j)DRESS /�/ Seel-) 5 tie e t /U61 r /c i-4-4 01 7 67 . CITY OR TOWN STATE ZIP CODE The current exemption for'Homeowner'was extended to include owner—occupied dwellines of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1) Definition of Homeowner: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to be,a one or two family attached or detached structure assessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner;such"homeowner"shall submit to the building official,on a form acceptable to the building official,that he/she shall be responsible for all such work performed under the buildine permit.(Section 110 R5.1.3.1) The undersigned`homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes,by-laws,rules and regulations. The undersigned'homeowner' certifies that he/she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he/ she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE / _./ APPROVAL OF BUILDING 01-1.1CIAL INSURANCE COVERAGE: I have a current .ity insurance policy or its substantial equivalent,which meets the requirements of MGL Ch.142. es No If lease indicate the type coverage by checking the appropriate box. A liability insurance policy, Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent h:homeownrticexemp